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Emerging Peripheral Receptor Targets for Deep-tissue Craniofacial Pain Therapies

R. Ambalavanar^*, and D. Dessem

Department of Neural and Pain Sciences and Program in Neuroscience, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA
Both authors contributed equally to this work

Correspondence: rambalavanar{at}umaryland.edu

While effective therapies are available for some types of craniofacial pain, treatments for deep-tissue craniofacial pain such as temporomandibular disorders are less efficacious. Several ion channels and receptors which are prominent in craniofacial nociceptive mechanisms have been identified on trigeminal primary afferent neurons. Many of these receptors and channels exhibit unusual distributions compared with extracranial regions. For example, expression of the ATP receptor P2X₃ is strongly implicated in nociception and is more abundant on trigeminal primary afferent neurons than analogous extracranial neurons, making them potentially productive targets specifically for craniofacial pain therapies. The initial part of this review therefore focuses on P2X₃ as a potential therapeutic target to treat deep-tissue craniofacial pain. In the trigeminal ganglion, P2X₃ receptors are often co-expressed with the nociceptive neuropeptides CGRP and SP. Therefore, we discuss the role of CGRP and SP in deep-tissue craniofacial pain and suggest that neuropeptide antagonists, which have shown promise for the treatment of migraine, may have wider therapeutic potential, including the treatment of deep-tissue craniofacial pain. P2X₃, TRPV1, and ASIC3 are often co-expressed in trigeminal neurons, implying the formation of functional complexes that allow craniofacial nociceptive neurons to respond synergistically to altered ATP and pH in pain. Future therapeutics for craniofacial pain thus might be more efficacious if targeted at combinations of P2X₃, CGRP, TRPV1, and ASIC3.

Key Words: trigeminal • nociception • muscle • TMD • neuropeptides

Journal of Dental Research, Vol. 88, No. 3, 201-211 (2009)
DOI: 10.1177/0022034508330176


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